Healthcare Provider Details

I. General information

NPI: 1679533616
Provider Name (Legal Business Name): DR. MUKESHCHANDRA D PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 N FARNSWORTH AVE
AURORA IL
60505-3004
US

IV. Provider business mailing address

3331 WHITE EAGLE DR
NAPERVILLE IL
60564-4605
US

V. Phone/Fax

Practice location:
  • Phone: 630-898-0022
  • Fax:
Mailing address:
  • Phone: 630-898-0022
  • Fax: 630-898-2933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036087643
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: